1. CONFERENCE DETAILS Current Date:…………….……

Conference Name:………………………………………………..…………………………………………………..…………..…

Date of Conference….………………..….…( DD/MM/YY),Place of Conference..…..…………………….………

2.

Note: It is Mandatory to fill

+

Listener’s Registration ID (*)………………………………..……………. (Kindly mention this while communicating in future with Team IRAJ)

3. NAME AND CONTACT DETAILS

Listener’s First Name Middle Last

Age______ ___ , SEX _ _ _ _ _ _ _ _ _ _ _ _ ( M/F)

City State

Country

Correspondence Postal address (*)…………..………………………..…….

………………………………………………………………………………………………

………………………………………………….Postal Pin…………………………… Mobile Number (*)……………………………………………………………….…

Alternate Contact Number……………………………………………………… Email (*)……………………………………………….……..…………………….….. 4. AFFILATION

4.1College/University/Company(*)…………………………………………

……………………………………………….………………………………………………

…………………………………………………………………………………………..

4.2 Designation (Student/Asst. Prof/Associate Prof/Professor/

/Research Associate/Others…………………………………….…………...

4.3Qualification (*) Graduation……………………………….…………....

Post Graduation…………..……………………………………………….…….

PhD./Post Doc……………………………………………………………….….

4.4 No of Conference/Events Attended……………………….……………

4.5 No of paper published………………………………………………………

5. PAYMENT DEATAILS

Amount…………………(USD/INR)Mode of transfer ……………………

Bank Details………………………….……………………………………………....

Transactions ID…………………………………………………………….….…...

Date of Transfer (DD/MM/YY)…………………………………………........

(Mode of transfer:

Online /Internet Banking/Cash deposit at bank /NEFT ) only

PURPOSE TO ATTEND THE CONFERENCE/EVENT(*)

All (*) marked

6. OTHER DETAILS

6.1 How did you get the information about this conference?

Email allconferencealert.com

From College News Paper

Referred by Friends Referred by Professor

Other Websites………………………………………………(Specify)

6.2 Have you attended any conference organized by IRAJ or its

allied group before?

Yes (Paper ID……………………………………….. ………) No

6.3 Will you personally attend the Event?

Yes No

6.4 No. of Persons attending the event with you?(Including your

Co-authors)________________________________________ .

6.5 Will your Professor/Guide/HOD/Principal attend the Event

_______________________________________(Y/N)

6.6 IRAJ Membership ID………………………………………………………...…….. (Applicable for Existing IRAJ Members Only)

7. DECLARATION/UNDERTAKING(*) (Read Carefully before Sign)

1. I will not cause or be involved in any sort of violence or disturbance, within or outside of the Conference/Event Venue and during my travel to the venue in any Country during my Visa Period. 2. IRAJ has all rights reserved to shift the venue, rescheduling the date and timing of the Event at any time. 3. In case of cancellation or re-scheduled of this event to other place or date at any time , IRAJ will be not responsible for any kind of financial loss due to ticket cancellation or any other bookings done by me 4. I do hereby declare that all the information given by me is true and if at any moment it is found to be wrong, my registration for the event will be cancelled by IRAJ and necessary action will be taken against me. 5. IRAJ is not responsible for any violation of Rules and Regulations by me at any country during or after the Event. 6. The refund will be done if decided by IRAJ management will be done as the same mode as I paid and will take 7 to 60 days from the day of refund process starts. 7. This conference/seminar is a multidisciplinary in nature which may have presentations other than my interest. 8. I clearly understood the procedure for publication, registration and attending the seminar. I have read all the rules and regulations at http://iraj.in/rules.php and above Declaration & Undertaking and I agree.

Listener’s Signature (*)……………………………………………………..…………….

NOTE: Send the scan copy of this form and Payment proof to Official mail ID (Only) of the conference before last date of Registration and bring this to the

venue while attending the event with a valid ID Proof. * All rights reserved by Institute of Research and Journals(IRAJ)

(A unit of Peoples Empowerment Trust)

LISTNER REGISTRATION FORM (Fill all Information in CAPITAL format only)

Paste your Photo Here

INSTITUTE OF RESEARCH

AND JOURNALS (IRAJ)

Optional page

Other Information(If any)……………………………………………………………............................................

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………..